The proposal — designed to bolster a strained behavioral health system that serves as a public safety net for people in need of care — is one of many changes, including $1 billion in tax breaks, that Youngkin wants to make in the biennial budget lawmakers will consider. when they meet in Richmond in mid-January.
“We are facing mental health and substance abuse issues like never before, all too often leading to violence, suicide and murder,” Youngkin said in a video of the announcement made at a suburban Richmond hospital. “The behavioral health crisis is not unique to Virginia, but let’s be clear, we are in a crisis here in Virginia.”
Virginia’s state mental hospitals have been under pressure for years. Officials last year closed several public hospitals to new admissions when the pandemic worsened overcrowding and staff shortages. Youngkin’s plan aims to provide pre-crisis, crisis and recovery services to patients before they need inpatient psychiatric care.
On Monday, his office created a TDO Rapid Placement Task Force to quickly find services for people court-ordered to provide crisis care, who often lie in emergency rooms for days, require constant attention from law enforcement and can be transported away from their families and support systems when a bed is available.
Youngkin announced its behavioral health initiative, called Right Help, Right Now, at Parham Doctors’ Hospital, a campus of Henrico Doctors’ Hospital operated by HCA, which hospital officials say is the largest private mental health provider care in the state.
Public and private hospitals are at odds over who is responsible for patients who have nowhere to go; private hospitals admit the largest number of patients in crisis, but mental health advocates say they avoid the most challenging cases, leaving a public hospital to care for aggressive and agitated patients.
Virginia calls for funding for crisis centers as an alternative to prisons
Youngkin said the scale of the problem is huge: Jails, emergency rooms and hospitals are seeing too many people in crisis, and law enforcement, teachers and health care providers are overwhelmed. He complained about Virginia’s ranking of 48th in the nation in youth mental health, which had fallen from 21st the previous year, according to data from Mental Health Virginia. The ranking is based on several factors, including the number of young people with at least one major depressive episode in the past year, the number who did not receive mental health services and the number of private insurances that do not cover mental or emotional problems.
Reform efforts in Virginia have long been driven by tragedies that thrust the state into the national spotlight: a 2007 mass shooting by a volatile student that killed 32 people at Virginia Tech; the 2013 suicide of state Sen. R. Cray Deeds’ son, Gus, who attacked his father after efforts to secure emergency mental health treatment failed. Last month, a man who co-workers said had displayed disturbing behavior fatally shot six people at a Walmart in Chesapeake.
John Littell, Youngkin’s health and human resources secretary, said in an interview Thursday that the plan was informed by months of meetings, studies and a comprehensive review of recommendations by the Commission on Behavioral Health, informally known as the Case Commission. In the fall, the state hired McKinsey consultants to complete the work.
The plan is inspired by Arizona’s model, which links crisis hotlines, mobile crisis units and drop-in centers like the kind Youngkin is proposing to expand to provide care in the first 24 hours of a mental health emergency, Littell said.
Littel acknowledged that recruiting will be a challenge, but said it’s too early to say how many people need to be hired; a detailed implementation plan is scheduled to be completed early next year, including dashboard tracking initiatives.
“We recognize that it’s going to take some really extraordinary efforts to make sure we have a pipeline,” he said. “I don’t think we have a magic wand here.”
Anna Mendez, executive director of Haven, a Charlottesville day shelter and homeless service provider, said she hesitated to downplay the potential for transformative change, but noted that the next steps will be critical. For example, although the plan includes $8 million to house 100 people with serious mental illnesses, she said that without qualified discharge planners to place clients, “100 new slots won’t matter”.
“What remains to be determined is whether we’re willing to invest in paying people enough money so that they want to do the work to make that happen,” she said.
Deeds (D-Bath) said he was impressed with the level of commitment from Youngkin, who called him Saturday to brief him on the plan, but said two or three times more funding is needed to address the service shortfall , including labor shortages. Statewide, the agencies that form the backbone of Virginia’s public behavioral health system, community service tips, have 28 percent vacancies, he said.
Last year, about $100 million for behavioral health, including $37 million in CSB salary increases, was cut from the final budget in compromises made to achieve the governor’s tax cuts, Deeds said.
He questioned whether the scope of the plan was sacrificed to pay for part of his proposed tax cut.
“He’s saying we’re going into a recession, so their idea of maybe a big, bold plan should be seen in that context,” Deeds said. “They want to do other things so that this plan doesn’t seem as bold as they would like it to be.”
Dades said he hopes Youngkin’s plan is the smallest part of what the Legislature will spend to strengthen community behavioral health services.
“I’ll work like hell for more,” he said.